Value of PSA Density, PSA Velocity and Percent Free PSA for Detection of Prostate Cancer in Patients with Serum PSA 4-10ng/ml Patients

Lee, Seung Chan; Lee, Sang Cheol; Kim, Wun Jae

Abstract

Purpose
This study investigated whether the PSA density (PSAD), PSA velocity (PSAV) and percent free PSA (F/T PSA) might be valuable in predicting prostate cancer in men with serum PSA levels of 4-10ng/ml.
Materials and Methods
Prostate biopsy data were obtained from 1,020 patients out of 1,165 men with serum PSA levels of 4-10ng/ml. The prostate volume was estimated by transrectal ultrasonography, and the levels of total PSA and free PSA determined by a radioimmune assay. The PSAD, PSAV and percent free PSA were calculated from these data. A receiver operating characteristic curve (ROC) was generated and utilized to evaluate the cut-off values of PSAD, PSAV and percent free PSA.
Results
Of the 1,020 patients, 119 (11.7%) had prostate cancer and 901 (88.3%) had various benign conditions, mainly BPH, on pathological examination. The mean values of PSAD and PSAV were significantly higher in the prostate cancer patients than the non-prostate cancer cases (p<0.001). However, the F/T PSA in each group were not different, which was in contrast to western data (p=0.09). The area under the PSAV ROC curve was significantly larger than that of the total PSA ROC curve in the PSA range between 4-10ng/ml. The PSAD (based on a cut-off value of 0.15) had a sensitivity and specificity of 83.7 and 39.9%, respectively, for diagnosing prostate cancer, while the results for PSAV (based on a cut-off value of 0.75) were 64.9 and 78.4%, respectively. In men with serum PSA levels of 4-10ng/ml, the analysis of the sensitivity and specificity showed that the PSAD and PSAV had higher sensitivities and specificities.
Conclusions
These results suggest that the PSAD and PSAV might be useful parameters for the detection of prostate cancer in men with serum PSA levels of 4-10ng/ml.